That the Information Given Above Is Correct (28)

Application for approval of an asset as collateral for credit S.B1

Send to [email protected] Numbers in brackets refer to instructions for application form Riksbank’s own note Date (1) Date of arrival(2)

Applying institution (3) Contact person, - Name, e-mail and telephone (4)

Issuer

Issuer (5) Issuer group (6) Issuer’s country of domicile (7)

Long-term rating (definitive) (8) Fitch(8) Moody's S&P

Asset ISIN (9) Asset type If government guaranteed assset: (10) Domicile of guarantor(11) Guaranteeing local-government (12)

Asset rating (definitive) (13) If asset is guaranteed: The guarantor’s rating (14) Fitch Moody's S&P Fitch Moody's S&P

If asset is covered – does it comply with the requirements in the UCITS-directive (15)

If asset is guaranteed by local-government – has the local government unlimited taxation rights (16)

Maturity date (17) Coupon definition (18) Coupon rate (19) Currency (20)

Outstanding amount (21) Central securities depository (CSD)Country (22) of original registration (23)

Listed on stock exchange or other regulated market (24) Stock exchange country of domicile(25)

Applying institution’s relation to issuer (26) Institution is related to issuer WeInstitution herby isconfirm not that the asset does not have subordinated payment rights (subordinated debentures) (27)

that the information given above is correct (28)

Signature of the institution (27)

For the Riksbank’s own notes Liquidity category Group (A/B)

Comment

Checked by Price source approved by Registered Controlled

The Riksbank’s decision  Application approved  Application denied

Date On behalf of the Riksbank

R I X Forms – S.B1 April 2015